Dietary nitrate and nitric oxide
Restoring nitric oxide — dietary nitrate (beets/leafy greens), sunlight, exercise. Heart & cardiovascular. Reviewed Sep 2026.
Lowers systolic blood pressure by about 3 to 5 mmHg in randomised trials, but there is no outcome data showing it prevents heart attacks, deaths or plaque.
What it is
The endothelium normally makes nitric oxide (NO) via the eNOS enzyme. A second, independent route exists: nitrate from beetroot and leafy greens is reduced by oral bacteria to nitrite and then to NO — it works even when eNOS is impaired. UVA light mobilises NO stores in the skin, and the shear stress of exercise is the main physiological trigger for endothelial NO.
The evidence
Solid for blood pressure: RCT meta-analyses show roughly −3.5 to −4.4 mmHg systolic (about −5 mmHg in hypertensives), and a randomised phase-2 trial (Kapil, Hypertension 2015) showed sustained BP lowering plus improved endothelial function over 4 weeks in hypertensive patients. Mechanism is strong in animals: dietary nitrate reversed features of metabolic syndrome in eNOS-knockout mice (Carlström, PNAS 2010). What is not shown: no randomised trial has demonstrated that dietary nitrate reduces heart attacks, deaths or plaque progression, and a 2024 4-week crossover RCT in treated hypertensives found no vascular-function or BP benefit. Treat “coronary disease can be stopped” as an untested hypothesis. One claim circulating with this idea is simply wrong: LDL-lowering trials did not show “zero mortality benefit” — the CTT meta-analysis of 170,000 patients found −10% all-cause mortality per 1 mmol/L LDL reduction. FOURIER alone showed −15% events without a cardiovascular-mortality signal in short follow-up; one trial is not all trials.
What you can do today
This is available today. Whether it suits you depends on your health, your other medicines and your risks, so discuss it with a clinician who knows your history before starting or changing anything.
Sources
- Primary sourcepubmed.ncbi.nlm.nih.gov
Change history
Restoring nitric oxide added to Heart and cardiovascular, at "Available now" for blood pressure only.
Solid RCT evidence for a 3 to 5 mmHg systolic drop. No trial shows it prevents heart attacks or plaque. The source thread's claim that LDL trials showed no mortality benefit is false and is corrected in the entry.
Nitric oxide entry: the source thread claimed LDL-lowering trials showed "zero mortality benefit". That is false. The CTT meta-analysis of about 170,000 patients found roughly 10% lower all-cause mortality per 1 mmol/L LDL reduction.
The thread was not added to the feed. The underlying science on dietary nitrate and blood pressure was staged on its own merits.
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